Patient perception of quality following a visit to a doctor in a primary care unit

Background. Assessment of the quality of primary care services may be enhan ced by including patient perceptions as well as professional judgment of qu ality. There is a need for reliable and valid instruments to measure these perceptions. Objectives. (i) To present a scale for measuring patient perception of qual ity of care following a visit to a doctor; and (ii) to analyse the response s given by patients recruited in primary care units in the Montreal region. The scale is composed of 22 items regrouped into th ree sub-scales referri ng to the patient-physician relationship (five items); the technical aspect s of care (12 items); and the outcomes of the visit (five items). Distincti ve features of the scale are that it focuses on patients' opinions about qu ality rather than on satisfaction, and that it includes items related to ou tcomes of the visit. Methods. A survey was conducted on 473 patients who visited a physician in 11 primary care units in the Montreal region. Randomly selected patients re ceived mailed questionnaires 5-7 days following their visit. Various statis tical procedures were used to assess the reliability and the validity of th e global scale and the sub-scales, and to analyse patients' patterns of res ponse. Results. The analysis of the psychometric properties of the global scale an d the three subscales provides favourable evidence concerning their reliabi lity and validity. The results of the factor analysis, the inter-item corre lations and the Cronbach's alpha coefficients all support the distinction m ade between the interpersonal processes, the technical processes and the ou tcomes, and, at the same time, confirm the complex nature of the notion of perceived quality. The analysis of patients' responses allows the identific ation of items associated with global perception about quality of care. Th is global perception results from patients' perception of the physician's p rofessional and interpersonal skills as well as from the outcomes of care. Conclusion. The scale can be used by physicians or primary health care unit s and has a wide range of applications.